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Palmar erythema is a very unusual manifestation of sarcoidosis. We report on a patient whose presenting features of sarcoidosis were palmar erythema and a hoarse voice. The diagnosis was confirmed by palmar skin biopsy and the patient responded well to treatment with prednisolone.
We describe 3 patients with dermatomyositis who presented with flagellate erythema. This cutaneous eruption is characterized by erythematous linear lesions on the trunk and proximal extremities. Histologic examination of this eruption in one of our cases revealed an interface dermatitis. Review of the literature and records of 183 patients with connective tissue diseases from our institution has shown that this peculiar eruption has been reported only in dermatomyositis. Because of the location of this eruption, we encourage the use of the term "centripetal flagellate erythema" to distinguish this entity from other linear eruptions seen in patients with connective tissue diseases.
Effects of ultraviolet radiation (UV) on the human skin are summarized in the introductory part from physical and biological point of view, especially photoaging and photocarcinogenesis. Special attention has been paid to skin phototype which characterizes the individual susceptibility to UV. The minimal erythema dose (MED) serves for establishment of this susceptibility. The mean MEDs for white population in other countries are also shown here. Mechanisms of natural photoprotection in connection with instructions how to increase artificial photoprotection are described here. The investigation of skin type incidence in our population and determining their mean MEDs for UV-B and polychromatic light was the aim of practical work. The UV-B MED is in average 23.4 mJ/cm2. The further work has been concentrated on the assessment of pigmentation response after irradiation and especially on the comparison of the minimal erythema doses before season and after it. We found mean double increase of the MED after sunlight exposition during summer season. We suggested, that double increasing of seasonal natural photoprotection does not represent definitive protection for most people and does not impair summer warning system in media which is based on winter MEDs. Some recommendations for improvement of protection of Czech population against UV radiation are proposed in conclusion.
Erythema chronicum migrans is characterized by an expanding erythematous band about an arthropod bite. While rare, it is an important disease to recognize because of its rapid response to even modest doses of antibiotics. This response and the association with arthropod bites suggest a microbial vector. Richettsial titers have been demonstrated in several cases but we were unable to show them in our patient, who we believe is the second reported case of erythema chronicum migrans incurred by an American without traveling abroad.
The article reviews existing clinical trials of the treatment of erythema migrans, localized early manifestation of Lyme disease. Although the treatment of this phase of Lyme disease is the best studied of all clinical manifestations, some questions remained to be answered. Author critically reviews definitions of the treatment success. Methodological diversities of the trials are emphasized. Often, treatment recommendations are not supported by existing clinical trials. Unnecessary use of antibiotics in the treatment and prophylaxis of erythema migrans is emphasized, too.
We report the case of a woman who after taking ampicillin and amoxicillin developed two severe cutaneous reactions with generalized erythema and maculopapular rash, which later turned into blisters with subsequent desquamation. She was clinically diagnosed with erythema multiforme syndrome after positive delayed cutaneous tests with benzylpenicillin, amoxicillin and ampicillin allowed for a more specific diagnosis. There are very few references to patients with drug reactions to betalactams who have positive skin prick or intradermal test but show delayed hypersensitivity, as was the case in our patient.
Erythema multiforme is an immunologically mediated skin reaction to a foreign antigen and can occur with many drugs. We report the first two cases of erythema multiforme induced by 5-fluorouracil (5-FU). The first case was in a man with inoperable gastric carcinoma being treated by continual infusion who developed the classic rash involving the neck and upper chest, along with mouth ulceration and plantar-palmar erythrodysaesthesia. Histological confirmation was made by skin biopsy and the lesions resolved spontaneously. They recurred on restarting 5-FU. The second case was in a woman being given adjuvant bolus 5-FU and folinic acid for Duke's C colon cancer who developed the rash during the first cycle. Again, the lesions settled spontaneously but recurred more severely on the second cycle. When treatment was changed to the specific thymidylate synthase inhibitor, raltitrexed, the course was completed uneventfully.
A case of a 47-year-old man with skin lesions of erythema multiforme and macroglobulinemia is reported. Histological changes corresponded with mixed dermoepidermal type of erythema multiforme and direct immunofluorescence showed fibrillar band with anti-IgM and anti-fibrin on basement membrane. Further examination revealed serum monoclonal IgM kappa with traces in urine. Association or coincidence of these findings is discussed.
Erythema ab igne caused by chronic heat exposure presents as a net-like hyperpigmentation of the skin. We report this condition rapidly evolving due to the inadvertent use or dysfunction of an adjustable-temperature blanket in the intensive care unit. The use of heating/cooling blankets, especially in a patient with altered mental status, can result in iatrogenic erythema ab igne.
We describe a patient diagnosed with lupus erythematosus (LE) who developed an acute generalized eruption characterized by erythema multiforme (EM)-like lesions. Biopsy specimen showed foci of vacuolar alteration at the dermo-epidermal junction and frequent necrotic keratinocytes. Laboratory tests disclosed a speckled-homogenous antinuclear antibody titer of 1:640, leucopenia and hypocomplementemia. Anti-Ro/anti-La antibodies and rheumatoid factor were negative. Treatment with high-dose oral prednisone and azathioprine led to complete remission of the cutaneous lesions, although eruption recurred two years later. We believe that this patient presented a subacute cutaneous lupus eythematous with a distinctive erythema multiforme-like eruption. This case could be included in the so-called Rowell's syndrome, although it does not fit all the immunological characteristics reported in the original description, as in many of the previously reported cases. At the present time there seems to be enough evidence to classify Rowell's syndrome within the subacute cutaneous lupus erythematosus subset. Finally, a coexistence of LE and EM can not be completely discarded in our patient, although no causative factor was found.
BACKGROUND: Relapsing polychondritis is a rare systemic disease. Skin involvement occurs in 20 to 50 % of cases. Cutaneous signs are most often related to a leukocytoclastic vasculitis. Association of relapsing polychondritis with neutrophilic dermatosis have also been reported. We report the first case of an erythema annulare centrifugum-like dermatosis associated with relapsing polychondritis, with a two years delay between both conditions. CASE REPORT: A 74 year-old man was seen for papulo-erythematous centrifugal annular lesions that appeared 18 months earlier in a context of bad general conditions. Biological tests were normal. Several skin biopsies were performed, showing at the beginning features of drug reaction and then of lupus-lichen. Treatment with hydroxychloroquine, topical corticosteroids, dapsone and thalidomide were unsuccessful. In the following months, the patient developed fever and relapsing bronchitis. Suddenly, a chondritis of the ears appeared, leading to the diagnosis of relapsing polychondritis. All the cutaneous, chondritic and respiratory signs disappeared with oral steroid therapy. Two years after the diagnosis of relapsing polychondritis the patient developed refractory anemia. DISCUSSION: Cutaneous signs of relapsing polychondritis are frequent and may occur several months or years before the chondritis. They are polymorphous, but to the best of our knowledge, a clinical aspect of erythema annulare centrifugum has never been described. Our observation recalls the sometimes long delay between the cutaneous and the chondritic signs of relapsing polychondritis and the high frequency of dysmyelopoiesis in relapsing polychondritis with cutaneous involvement.
A 48-year-old Japanese man developed coalesced erythema multiforme-like lesions on the forearms and the dorsa of hands that were exposed to a cutting oil product. Subsequently, multiple, round erythematous lesions with iris formation occurred on the trunk and four extremities that had no direct contact with the oil. It is suggested that erythema multiforme can be induced via some allergic processes following a contact reaction.
The high rate of dermatologic adverse effects associated with bupropion use may extend to its sustained-release preparation, currently prescribed extensively for smoking cessation as well as for treatment of depressive conditions. We report what we believe to be the first case, in a 31-year-old woman, of erythema multiforme after administration of sustained-release bupropion (Wellbutrin SR) for treatment of depression. This report emphasizes that prescribers must aggressively follow up their patients who have rashes or urticaria, discontinuing the medication as soon as erythema multiforme is suspected and watching closely for the emergence of potentially life-threatening dermatologic conditions.
INTRODUCTION: In Europe, Borrelia burgdorferi sensu stricto, Borrelia afzelii and Borrelia garinii are known as pathogens among the Borrelia burgdorferi sensu lato group. Since it is not yet known which Borrelia are responsible for Lyme borreliosis in France, the objective of this study was to identify the species of Borrelia responsible for erythema migrans in the region of Alsace, France. PATIENTS AND METHODS: Eighteen patients with erythema migrans (EM) of more than 5 cm of diameter were included in this prospective study. All patients were investigated at the Strasbourg University Hospital. Patients were biopsied on the active border of their lesion. Cutaneous biopsies of the active border of the lesion were cultivated in BSK-H medium (Sigma) and analysed in vitro by PCR after 8 weeks of culture, using flagellin consensus sequences which are present in all species of Borrelia burgdorferi sensu lato group as primers. Species-specific oligotyping was used for species identification. RESULTS: Among the 18 patients biopsied, 7 had evidence of borrelia infection revealed by culture and/or PCR. Borrelia afzelii was detected in 4 patients and Borrelia garinii in three. CONCLUSION: These preliminary results appear to confirm that Borrelia afzelii and Borrelia garinii are the predominant borrelial species in EM lesions in our geographic area, as in other European countries.
The level of stratum corneum hydration is assessed by measurement of the changes in skin resistance and is referred to as the galvanic skin response or electrical skin resistance. Skin erythema may be assessed by measurement of skin blood flow, tristimulus colorimetry or narrow-band reflectance spectroscopy. Currently available measuring devices are relatively expensive. Presented here are two inexpensive, hand-held, portable instruments which conveniently measure stratum corneum hydration and skin erythema.
The non-steroidal anti-inflammatory drugs, especially various pyrazole or pyrazolon derivatives, were one of the classes of drugs commonly implicated in erythema multiforme or Stevens-Johnson syndrome/toxic epidermal necrolysis. Reticular exanthem was a rare morphological pattern of maculopapular drug eruptions. Here we report a case of dimorphic exanthema presenting with partly reticular maculopapular exanthema and erythema multiforme-like lesions, associated with pyrazolon derivatives. Patch testing showed negative reaction to the suspected drugs. The possible mechanism underlying the association of dimorphic exanthema with NSAIDs is discussed.
A 49-year-old woman was admitted to our hospital with a dry cough and bilateral hilar lymphadenopathy. She had a history of acute arthralgia and erythema nodosum 4 months before admission. Chest CT scans on admission revealed multiple mediastinal lymphadenopathy. Broncho-alveolar lavage showed CD4-dominant lymphocytosis. A biopsy specimen of the lung revealed non-caseating granuloma of epithelioid cells with giant cells, confirming the diagnosis of sarcoidosis. She recovered in one month, and has since remained well and free of the symptoms. Löfgren's syndrome is acute sarcoidosis, characterized by polyarthralgia, erythema nodosum and bilateral hilar lymphadenopathy. It is common in European countries, but very rare in Japan, from where only two case reports have appeared. This syndrome is closely related to HLA-B8, DR-3, and DR-17, but our case did not have these HLA loci. We report this case as the third case of Löfgren's syndrome in Japan.
Malignant glucagonoma is rare and frequently associated with cutaneous manifestations such as necrolytic migratory erythema. We report the case of a patient who developed necrolytic migratory erythema 12 months before the diagnosis of malignant glucagonoma. Skin involvement recovered after surgical resection of a primitive pancreatic tumor and hepatic and ileal metastasis.